title: Reliability of Triggered EMG for Prediction of Safety during Pedicle Screw Placement in Adolescent Idiopathic Scoliosis Surgery.
abstract: METHODS
  We performed a prospective study to evaluate the reliability of using triggered electromyography (EMG) for predicting pedicle wall breakthrough during the placement of pedicle screw in adolescent idiopathic scoliosis surgery.
  
  
  OBJECTIVE
  We wanted to correlate pedicle wall breakthrough with the triggered EMG threshold of stimulation and the postoperative computed tomography (CT) findings.
  
  
  BACKGROUND
  Pedicle wall breakthrough has been reported to be difficult to evaluate by radiographs. Triggered EMG had been found to be a more sensitive test to detect this breakthrough.
  
  
  METHODS
  Seven patients who underwent the insertion of 103 pedicle screws were evaluated. The triggered EMG activity was recorded from several muscles depending on the level of screw placement. The postoperative CT scans were read by a spine surgeon who was a senior fellow in orthopedics, and a musculoskeletal radiologist.
  
  
  RESULTS
  The mean age at surgery was 12.6 years (range, 11 to 17 years). The preoperative mean Cobb angle was 54.7° (range, 45 to 65°). There were 80 thoracic screws and 23 lumbar screws. All the screws had stimulation thresholds of ≥ 6 mA, except 3 screws with the stimulation threshold of < 6 mA. Ten screws (9.7%) showed violation of the pedicle wall on the postoperative CT scans. Five screws penetrated medially and another five penetrated laterally. No postoperative neurologic complications were noted in any of the seven patients.
  
  
  CONCLUSIONS
  Measuring the stimulation threshold of triggered EMG helps to assess the pedicle screw placement. Pedicle screws that had stimulation threshold of ≥ 6 mA were safe, with 90.3% reliability, as was assessed on the postoperative CT scans.
authors.affiliation: Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Woo-Kie
authors.initials: WK
authors.lastname: Min
authors.forename: Hyun-Joo
authors.initials: HJ
authors.lastname: Lee
authors.forename: Won-Ju
authors.initials: WJ
authors.lastname: Jeong
authors.forename: Chang-Wug
authors.initials: CW
authors.lastname: Oh
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Bae
authors.forename: Hwan-Seong
authors.initials: HS
authors.lastname: Cho
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Jeon
authors.forename: Chang-Hyun
authors.initials: CH
authors.lastname: Cho
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Park